New technology will improve the delivery of healthcare. When asked to conjure an image of the typical physician, most people will describe a person wearing a white lab coat, with a stethoscope around their neck and a chart in their hands. This simple image neatly captures three key activities performed by the doctor, namely, the collection of data (using instruments such as the stethoscope), the recording of information (usually onto a paper chart) and the analysis of the information (using the doctor’s training and experience) to make a diagnosis. Unfortunately, as healthcare grows ever more complex, the information needed to diagnose a patient’s condition is increasingly scattered across a myriad of different systems, some of which are electronic, many of which are still paper-based.
eHealth, the application of information and communications technology to improve healthcare services delivery, offers the promise of simplifying this complex situation so that a healthcare provider can quickly and easily retrieve all information about a specific patient, perhaps even on a device that mimics the traditional paper chart.
Tipping Point
eHealth has reached a "tipping point "beyond which implementation will accelerate rapidly. Although there are certainly many challenges to overcome and risks to be addressed, there is a growing consensus that eHealth can facilitate the transformation of healthcare services delivery in ways not previously possible. eHealth is no longer a question of "Why?" but of "How?"
Why is eHealth important?
A 1999 Institute of Medicine report, “To Err is Human: Building a Safer Health System,” concluded that preventable hospital-based medical errors are the eighth-leading cause of death in the United Stated. An estimated 44,000 to 98,000 Americans die each year from medical errors such as incorrect medication administration, the equivalent to one passenger jet crashing and killing all occupants each and every day of the year. A similar situation exists in Canada. In addition to an alarming incidence of preventable deaths, the cost of providing healthcare in Canada has been increasing, on average, six per cent per year. Assuming no significant change to the underlying factors driving healthcare costs, the Conference Board of Canada predicts that by 2020 some provinces might be spending more than half of their annual operating budgets on healthcare services delivery.
Faced with a need to protect patient safety as well as to increase productivity as a partial means of addressing rising costs, healthcare, like other industries, is turning to Information and Communications Technology (ICT). Although ICT has been used for decades in hospitals, it has largely been employed in “back-office” applications, with front-line healthcare providers relying on pen and paper. By integrating ICT into front-line healthcare service delivery processes, eHealth can help reduce medical errors by making health information more readily accessible. Further, eHealth can reduce costs by saving time, reducing duplication and improving efficiency, savings that can reduce healthcare costs by as much as 10%.
Canadian eHealth trends
While every Canadian citizen has access to publicly funded healthcare, the manner in which the healthcare system is structured, funded, and governed varies from province to province. This situation can best be described as “variations on a theme” and it extends to eHealth, with every province setting its own priorities and timetable for eHealth adoption. Notwithstanding the provincial variations, several major healthcare trends are emerging that have a direct impact on eHealth adoption:
o The consolidation of healthcare services delivery, through either hospital amalgamation or regionalization.
o The vertical integration of healthcare services delivery across the continuum of care primarily through regionalization.
o Third-party provisioning of eHealth service through various mechanisms including outsourcing, shared service organizations and partnering between several healthcare organizations.
o Strong senior-level support for eHealth within healthcare organizations, regional health authorities, and provincial ministries of health.
o Alignment of provincial eHealth agendas with priorities set by Canada Health Infoway, a federal organization created to foster and accelerate the development of pan-Canadian electronic health information systems.
Modern Processes
Effective healthcare service delivery is heavily dependent upon timely access to relevant patient information. Existing manual, paper-based processes simply cannot keep pace with the explosion of information and ever more complex diagnostic and treatment options. eHealth will provide patients and healthcare providers alike with the tools needed to easily and quickly access the information needed to make timely and effective decisions, thereby increasing patient safety, and improving overall healthcare system efficiency.
Variations on Common Themes
Political debate in Canada often focuses on what makes one province or region different from the others. While it is possible to extend this same focus on provincial differences to an examination of eHealth, most differences were largely variations on a number of common themes, including:
• Regionalization
• Electronic Health Records
• Digitizing healthcare processes
• Provincial eHealth strategy
• Patient at the centre of care
• Provincial connectivity
Differences in how the provinces address the various common themes are driven by a myriad of factors including geography, demographics, and economics. The result is distinct provincial
eHealth agendas and strategies that reflect local realities while, at the same time, sharing many common elements and approaches. Viewing the differences between provincial eHealth agendas and strategies as variations on common themes provides vendors and policy makers with a framework with which to develop Canadian eHealth strategies and tactics.
Electronic Health Records
Driven by concerns about patient safety, the Electronic Health Record (EHR) has emerged as an important means of reducing preventable medical errors by providing quick and ready access to relevant patient information. Although it is not the only eHealth application that will offer significant benefits, every province has or is developing an EHR strategy. This intense focus on the EHR, encouraged by investments from Canada Health Infoway Inc., is driving a variety of activities that will support other eHealth initiatives in addition to the EHR. Although the term "electronic health record" implies the existence of a single record for each person and a database in which such records are stored, an electronic health record is actually derived from data stored in multiple systems. Taking this perspective into consideration, an electronic health record initiative is really an enterprise integration project, with the patient and all data associated with that patient as the common integration point and the enterprise consisting of multiple healthcare facilities across the continuum of care.
Future Vision
By combining various predictions, a composite picture emerges in which:
• The existing "silos" of information and expertise no longer exist.
• "Patients" have become "consumers" of healthcare services and are taking a more active role in their care.
• eHealth technologies are in use across the continuum of care and are an integral, largely "invisible" component in the delivery of nearly all healthcare services.
• Healthcare providers make extensive use of mobile devices to access the information they need, when they need it, wherever they might be located.
• Clinicians are shifting from a mindset of having to remember everything to routinely consulting handheld devices and on-line applications to order tests, review test results, refine a diagnosis, select the most appropriate care plan, schedule therapy, and prescribe medication.
• Healthcare providers no longer need to be in the same room as the person they are treating in order to make a diagnosis or even deliver many aspects of care.
• Genetics, combined with eHealth technologies, is emerging as a means of creating personalized care plans and shifting the focus of care from cure to prevention.
